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Shifting the narrative: equity, evidence, effectiveness, and innovation in the era of Ending the HIV Epidemic

BACKGROUND: The use of evidence-based (EB) and evidence-informed (EI) criteria in determining the effectiveness of health interventions has been widely adopted by national and international agencies in their attempt to address health gaps, particularly around Ending the HIV Epidemic (EHE) initiative...

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Autores principales: Perez, Alexander, Galván , Rosy, Morejon, Milanes
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773439/
https://www.ncbi.nlm.nih.gov/pubmed/36544129
http://dx.doi.org/10.1186/s12939-022-01801-6
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author Perez, Alexander
Galván , Rosy
Morejon, Milanes
author_facet Perez, Alexander
Galván , Rosy
Morejon, Milanes
author_sort Perez, Alexander
collection PubMed
description BACKGROUND: The use of evidence-based (EB) and evidence-informed (EI) criteria in determining the effectiveness of health interventions has been widely adopted by national and international agencies in their attempt to address health gaps, particularly around Ending the HIV Epidemic (EHE) initiatives. Utilization of these rigorous standards has proven critical in making progress towards achieving EHE goals, yet many communities remain unreached and underserved despite widespread adoption of EB/EI standards in public health research and practice. Although a crucial tool for innovative healthcare delivery, emphasis on the use of EB/EI parameters has created bias within the cycle of knowledge creation that favors well-resourced institutions given their capacity to meet the rigorous evaluation standards required of EB/EI science. This bias can systematically exclude institutions more aligned with community needs, such as community-based organizations and other grass-roots initiatives, which may have long-standing interventions that more effectively engage marginalized groups but do not have the capacity to meet EB/EI standards. MAIN BODY: This paper will explore the manifestation of systematic bias and research inequity in the process of identifying and assessing EB/EI HIV care interventions through the lens of a Health Resources and Services Administration funded initiative, coined the Center for Innovation and Engagement, which supports people living with HIV in the United States. An overview of the initiative is provided along with examples of how promising interventions with positive outcomes for members of marginalized communities are excluded in place of interventions that meet traditional standards of scientific rigor but are not novel or particularly innovative. Themes around academic imperialism and power hierarchies will be considered along with key barriers, lessons learned, and recommendations for promoting more equitable EB/EI research practice. CONCLUSIONS: It is crucial for entities supporting public health interventions to prioritize equity and inclusion in all stages of funding, design, and implementation. This is particularly true for conditions, such as HIV, that disproportionally impact the most marginalized. This will require approaching EB/EI research with a critical lens towards power and a willingness to dismantle historical dynamics that perpetuate inequities as a way of encouraging truly innovative solutions to support those who need it most.
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spelling pubmed-97734392022-12-23 Shifting the narrative: equity, evidence, effectiveness, and innovation in the era of Ending the HIV Epidemic Perez, Alexander Galván , Rosy Morejon, Milanes Int J Equity Health Comment BACKGROUND: The use of evidence-based (EB) and evidence-informed (EI) criteria in determining the effectiveness of health interventions has been widely adopted by national and international agencies in their attempt to address health gaps, particularly around Ending the HIV Epidemic (EHE) initiatives. Utilization of these rigorous standards has proven critical in making progress towards achieving EHE goals, yet many communities remain unreached and underserved despite widespread adoption of EB/EI standards in public health research and practice. Although a crucial tool for innovative healthcare delivery, emphasis on the use of EB/EI parameters has created bias within the cycle of knowledge creation that favors well-resourced institutions given their capacity to meet the rigorous evaluation standards required of EB/EI science. This bias can systematically exclude institutions more aligned with community needs, such as community-based organizations and other grass-roots initiatives, which may have long-standing interventions that more effectively engage marginalized groups but do not have the capacity to meet EB/EI standards. MAIN BODY: This paper will explore the manifestation of systematic bias and research inequity in the process of identifying and assessing EB/EI HIV care interventions through the lens of a Health Resources and Services Administration funded initiative, coined the Center for Innovation and Engagement, which supports people living with HIV in the United States. An overview of the initiative is provided along with examples of how promising interventions with positive outcomes for members of marginalized communities are excluded in place of interventions that meet traditional standards of scientific rigor but are not novel or particularly innovative. Themes around academic imperialism and power hierarchies will be considered along with key barriers, lessons learned, and recommendations for promoting more equitable EB/EI research practice. CONCLUSIONS: It is crucial for entities supporting public health interventions to prioritize equity and inclusion in all stages of funding, design, and implementation. This is particularly true for conditions, such as HIV, that disproportionally impact the most marginalized. This will require approaching EB/EI research with a critical lens towards power and a willingness to dismantle historical dynamics that perpetuate inequities as a way of encouraging truly innovative solutions to support those who need it most. BioMed Central 2022-12-21 /pmc/articles/PMC9773439/ /pubmed/36544129 http://dx.doi.org/10.1186/s12939-022-01801-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Comment
Perez, Alexander
Galván , Rosy
Morejon, Milanes
Shifting the narrative: equity, evidence, effectiveness, and innovation in the era of Ending the HIV Epidemic
title Shifting the narrative: equity, evidence, effectiveness, and innovation in the era of Ending the HIV Epidemic
title_full Shifting the narrative: equity, evidence, effectiveness, and innovation in the era of Ending the HIV Epidemic
title_fullStr Shifting the narrative: equity, evidence, effectiveness, and innovation in the era of Ending the HIV Epidemic
title_full_unstemmed Shifting the narrative: equity, evidence, effectiveness, and innovation in the era of Ending the HIV Epidemic
title_short Shifting the narrative: equity, evidence, effectiveness, and innovation in the era of Ending the HIV Epidemic
title_sort shifting the narrative: equity, evidence, effectiveness, and innovation in the era of ending the hiv epidemic
topic Comment
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773439/
https://www.ncbi.nlm.nih.gov/pubmed/36544129
http://dx.doi.org/10.1186/s12939-022-01801-6
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